1013078450 NPI number — ROGER WILLIAMS RADIATION THERAPY, LLC

Table of content: (NPI 1013078450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013078450 NPI number — ROGER WILLIAMS RADIATION THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER WILLIAMS RADIATION THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013078450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MAUDE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02908-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-456-2690
Provider Business Mailing Address Fax Number:
401-456-6540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MAUDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02908-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-456-2690
Provider Business Practice Location Address Fax Number:
401-456-6540
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIATT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
630-936-8828

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013078 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com